Disagreeing with Discharge
Disagreeing with someone is not something new for me. I will freely voice my opinion (usually supported with data and anecdotes) to anyone who will listen and objectively discuss an issue with me.
In the case of discharging a patient from therapy, the decision is ideally the PT's; however, as a patient advocate I have the responsibility to ensure patients receive the best care to maximize their potential. No health provider has a crystal ball to determine whether a patient will advance any further from his current functional status. There have been too many incidences where patients do progress and eventually go home when most providers had given up hope.
All clinical decisions should be based on educated evidence (and supported by data), not on whether a patient and family is liked or disliked. A decision to discharge a patient isn't necessarily about whether the patient will make progress in the future. It's about whether he is making progress today with therapy intervention and if that intervention so skilled, only a therapist is able to provide the care. If one wishes to debate a discharge, I'll be happy to quote CMS and state regulations and if a therapist doesn't like the rules, then he shouldn't play the game.
The phrase, "I'm the PT and I make the clinical decisions regarding patient care," means absolutely nothing to me when I'm the advocate and make a couple of calls to the ombudsman, state therapy board, and Office of Inspector General. I'll allow the experts to determine whether discharging a patient is equivalent to abandonment of care and I would love to see the data a therapist presents while trying to defend this.